Transperitoneal versus retroperitoneal laparoscopic pyeloplasty in children: Randomized clinical trial

• Published in: Journal of pediatric urology 2015-06, Vol.11 (3), p.122.e1-122.e6
• Main Authors: Badawy, Haytham, Zoaier, Amr, Ghoneim, Tamer, Hanno, Ahmed
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; Children; Female; Humans; Kidney Pelvis - surgery; Laparoscopy; Laparoscopy - methods; Length of Stay; Male; Operative Time; Pediatrics; Prospective Studies; Pyeloplasty; Recovery of Function; Retroperitonoscopic; Treatment Outcome; Ureter - surgery; Ureteral Obstruction - surgery; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2014.11.019

Summary Introduction Laparoscopic pyeloplasty achieves good cosmetic and functional outcomes. Both transperitoneal and retroperitoneal approaches are used. No single study to date has compared the two approaches in a prospective randomized design. Objective We present a prospective randomized comparison between both approaches in children in a trial to define which technique is better with regard to multiple factors including operative time, hospital stay, recovery of bowel movement, analgesic requirement and complication rate. Study design In the period from June 2010 to September 2012, 38 children (25 boys and 13 girls) were operated laparoscopically. Children were randomized into Group I (19 children) operated by the transperitoneal approach, and Group II (19 children) operated by the retroperitoneal approach. Both groups were compared as regards to the operative time, anesthetic changes, and postoperative recovery. A minimum sample size required was calculated to be 19 for each arm based on previous studies of laparoscopic pyeloplasty, using a mean difference in operative time = 40 min, effect size = 0.95, an alpha of 0.05 and power 80% and an online sample size calculator. Statistical analysis was performed using SPSS software using the Fischer exact test, chi square test and Mann–Whitney U test. The operative time was the primary endpoint for comparison between both approaches. Results Median age (years) Median operative time (minutes) Median hospital stay (hours) Start oral feeding (hours) Transperitoneal 6 150 48 16 Retroperitoneal 5 129 24 10 P value 0.437 0.010 0.002 0.000 Discussion Our series is the first in the literature that compares in a prospective randomized design the transperitoneal and retroperitoneal laparoscopic pyeloplasty in children. Shouma et al. is the only prospective randomized study to compare both techniques in adult pyeloplasty. They had a significantly shorter operative time in the transperitoneal group however, the author in the discussion mentioned that he was at the start of the learning curve for retroperitonoscopic pyeloplasty when he conducted his study, which affected the result of the operative time. Hence, as mentioned above, we stressed the importance of a single surgeon with adequate equal experience in both techniques. The recovery of the intestinal motility and start of oral feeding were significantly faster in the retroperitoneal group compared to the transperitoneal group. In our opinion this can be explaine